Gender dilemma: Was Semenya really first among equals?

The case of Caster Semenya, the South African teenager who ran to victory in the women’s 800m final of the World Championships in Berlin and walked into a storm of controversy over whether she is a man or a woman, highlights the sensitive and sometimes ambiguous nature of human gender.

Semenya, who took gold on Wednesday in 1min 55.45sec, with Briton Jenny Meadows winning bronze, grew up as a woman and, according to her coach Michael Seme, has “nothing to hide” – Seme even offered inquisitive journalists the telephone numbers of her room-mates in Berlin who, he said, have seen her naked in the shower.

But her humiliation does not end here. Semenya now has to face a panel of experts convened by the International Association of Athletic Federations (IAAF) to adjudicate over challenges to her gender. The panel, consisting of a gynaecologist, an endocrinologist, a psychologist, an expert in internal medicine and another expert on “gender-transgender issues” will not give their final verdict on whether Semenya can keep her gold medal until a least the end of the month.

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Although Semenya, 18, is noticeably muscular and angular for a woman, the people closest to her are in no doubt that she is female. So it may seem strange that it can take weeks for a handful of experts to decide whether someone is a man or woman – but that’s because gender is not always a clear-cut issue.

“The very term ‘gender verification’ suggests that we could get at the truth. A team of experts will find out, but gender is complex. The current coverage of Semenya’s case illustrates how troubling gender is in sport,” said Professor Kath Woodward of the Open University, who has written a book on gender in sport.

“Images draw upon stereotypes of what constitutes masculinity and femininity, through comportment and appearance, even when they necessarily have very different bodies from their female non-sporting counterparts,” Professor Woodward said.

The importance of gender verification in sport comes down to the perceived advantage of being a man. Males have between 40 and 60 times the amount of testosterone than females, and testosterone, the male sex hormone, is critical to building up muscle bulk and so providing the physical strength that can determine the outcome of a competitive event.

In the early 1960s, when the first regular gender verification was introduced in international sporting events by the IAAF, women were subjected to rather crude physical examinations of their private parts, a humiliating procedure that female athletes understandably resented.

Later on, during the Mexico City Olympic Games in 1968, the sporting bodies introduced a genetic test based on a smear taken from the mouth. The cells in the smear were analysed using a “sex chromatin” test to determine whether the person has the two XX chromosomes of a female, or the XY chromosomes of a male.

In addition to being less demeaning to women, it was also meant to deal with cases of ambiguous external genitalia. In some rare instances, men and women can suffer from a congenital condition that interferes with the normal development of their external sex organs.

The test, however, quickly fell out of favour, partly because of a shortage of labs that could carry it out properly. The test was also dogged by false positive and false negatives – in other words results that turned out to be wrong.

But an even bigger problem was the issue of women who were genetically male, having the XY chomosomes, but were in every other respects female because their bodies lacked a key protein that was able to recognise testosterone. These women produce large amounts of testosterone, but the hormone simply does not work.

The condition is known as “androgen insensitivity syndrome” and very often these women are unaware of it until they try to have children. About 1 in 20,000 women suffer from it, and although they look, feel and behave like women, a chromosome test alone would reveal that they are genetically male.

Sex determination in humans begins in the womb at an early stage of embryonic development. An egg normally carries one X chromosome while sperm carry either one X or one Y chromosome. When sperm and egg fuse, they form XX and XY embryos in a roughly 50:50 ratio.

During the first weeks of development, the male and female embryos are anatomically indistinguishable with primitive gonads – the male and female organs – beginning to develop in the sixth week of gestation. At this point they are considered to be “bipotential”, in other words they can go on to become either female ovaries or male testes.

What determines the eventual developmental path is the presence of the sex-determining gene on the male chromosome, called SRY. When this gene is present, the embryo becomes male, when it is not, it becomes female. In a way all embryos are by default female, and it is only when the SRY gene kicks in that a “female” embryo actually becomes male.

Part of the battery of laboratory tests that Semenya will now have to undertake is likely to be a test for the presence of the SRY gene. Her blood will also be tested for testosterone and her cells analysed for whether she bears the usual pattern of XX chromosomes for a woman.

But the IAAF has said that gender verification will not be done solely on such laboratory-based tests. A psychological profile is also likely to be done to determine whether she “feels” herself in her own mind to be a woman.

The IAAF’s policy on gender verification also states that there are medical conditions where people should be allowed to compete even when there are questions about their gender. Conditions such as androgen insensitivity syndrome and gonadal dysgenesis – when the gonads fail to develop or are surgically removed – are allowed because they confer no advantage over other female competitors.

Even sex-change men who become women can compete provided a period of time has elapsed since the operation, especially if carried out before puberty. It is all part of the realisation that being a man or a woman is not always clear cut.